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									                                                     SUICIDAL THOUGHTS & BEHAVIOURS
                                                      FIRST AID GUIDELINES

                              Purpose of these Guidelines
                              These guidelines are designed to help members of the public to provide first aid to someone who is at risk of suicide. The role of the first aider is
                              to assist the person until appropriate professional help is received or the crisis resolves.
                              Development of these Guidelines
                              The following guidelines are based on the expert opinions of a panel of mental health consumers, carers and clinicians from Australia, New
                              Zealand, the UK, the USA and Canada about how to help someone who may be at risk of suicide.
                              Details of the methodology can be found in: (…)
                              Although these guidelines are copyright, they can be freely reproduced for non-profit purposes provided the source is acknowledged.
                              Enquiries should be sent to: Professor Tony Jorm, ORYGEN Research Centre, Locked Bag 10, Parkville, VIC 3052, Australia,
                              How to use these Guidelines
                              These guidelines are a general set of recommendations about how you can help someone who may be at risk of suicide. Each individual is unique and it
                              is important to tailor your support to that person’s needs. These recommendations therefore may not be appropriate for every person who may be at risk
                              of suicide. Also, the guidelines are designed to be suitable for providing first aid in developed English-speaking countries. They may not be suitable for
                              other cultural groups or for countries with different health systems.

                              An important note:
                              Self-injury can indicate a number of different things. Someone who is hurting themselves may be at risk of suicide. Others engage in a pattern
                              of self-injury over weeks, months or years and are not necessarily suicidal. These guidelines can assist you only if the person you are helping is
                              suicidal. If the person you are assisting is injuring themselves, but is not suicidal, please refer to the guidelines entitled First aid for deliberate

                              How can I tell if someone is feeling suicidal?
                              It is important that you know the warning signs of suicide.

                              Signs a person may be suicidal:

                              •   Threatening to hurt or kill themselves
                              •   Looking for ways to kill themselves: seeking access to pills, weapons, or other means
                              •   Talking or writing about death, dying or suicide
                              •   Hopelessness
                              •   Rage, anger, seeking revenge
                              •   Acting recklessly or engaging in risky activities, seemingly without thinking
                              •   Feeling trapped, like there’s no way out
                              •   Increasing alcohol or drug use
                              •   Withdrawing from friends, family or society
                              •   Anxiety, agitation, unable to sleep or sleeping all the time
                              •   Dramatic changes in mood
                              •   No reason for living, no sense of purpose in life
                              Adapted from Rudd et al (2006).
                              Warning signs for suicide: Theory, research and clinical applications. Suicide and Life-Threatening Behavior, 36:255-262

People may show one or many of these signs, and some may show                    •   Has the person made a suicide attempt in the past? A previous
signs not on this list.                                                              suicide attempt makes a person more likely to make a future
If you suspect someone may be at risk of suicide, it is important to ask             suicide attempt or to kill themselves.
them directly about suicidal thoughts. Do not avoid using the word               Once you have established that the risk of suicide is present, you
‘suicide’. It is important to ask the question without dread, and without          need to take action to keep the person safe.
expressing a negative judgement. The question must be direct and to the
                                                                                 How can I keep the person safe?
point. For example, you could ask:
•    “Are you having thoughts of suicide?” or                                    A person who is actively suicidal should not be left on their own. If
                                                                                 you can’t stay with them, you need to arrange for someone else to do
•    “Are you thinking about killing yourself?”                                  so. In addition give the person a safety contact which is available at all
If you appear confident in the face of the suicide crisis, this can be           times (such as a telephone help line, a friend or family member who has
reassuring for the suicidal person.                                              agreed to help, or a professional help giver).
Although some people think that talking about suicide can put the idea           It is important to help the suicidal person to think about people or things
in the person’s mind, this is not true. Another myth is that someone             that have supported them in the past and find out if these supports
who talks about suicide isn’t really serious. Remember that talking              are still available. These might include a doctor, psychologist or other
about suicide may be a way for the person to indicate just how badly             mental health worker, family member or friend, or a community group
they are feeling.                                                                such as a club or church.
How should I talk with someone who is suicidal?                                  Do not use guilt and threats to prevent suicide. For example, do not tell
It is important to:                                                              the person they will go to hell if they die by suicide, or that they will
                                                                                 ruin people’s lives by killing themselves.
• Tell the suicidal person that you care and that you want to help
  them.                                                                          What about professional help?
• Express empathy for the person and what they are going through.                During the crisis
• Clearly state that thoughts of suicide are often associated with a             Mental health professionals advocate always asking for professional
  treatable mental disorder, as this may instil a sense of hope for the          help, especially if the person is psychotic. If the suicidal person has
  person.                                                                        a weapon or is behaving aggressively towards you, you must seek
• Tell the person that thoughts of suicide are common and do not                 assistance from the police in order to protect yourself.
  have to be acted on.                                                           However, the person you are helping may be very reluctant to
Suicidal thoughts are often a plea for help and a desperate attempt to           involve a professional and, if the person is close to you, you may
escape from problems and distressing feelings. You should encourage              be concerned about alienating them. In fact, some people who have
the suicidal person to do most of the talking, if they are able to. They         experienced suicidal thoughts or who have made plans for suicide
need the opportunity to talk about their feelings and their reasons              feel that professional help is not always necessary.
for wanting to die and may feel great relief at being able to do this.           After the crisis has passed
It may be helpful to talk about some of the specific problems the                After the suicide crisis has passed, ensure the person gets whatever
person is experiencing. Discuss ways to deal with problems which                 psychological and medical help they need. Other guides in this series
seem impossible to cope with, but do not attempt to ‘solve’ the                  may be useful for you in achieving this.
problems yourself.
                                                                                 What if the person makes me promise not to tell anyone
How can I tell if the situation is serious?
First, you need to determine whether the person has definite
                                                                                 You should never agree to keep a plan for suicide a secret. However,
intentions to take their life, or whether they have been having more
                                                                                 you should respect the person’s right to privacy and involve them in
vague suicidal thoughts such as ‘what’s the point of going on?’. To do
                                                                                 decisions regarding who else knows about their suicidal intentions.
this, you need to ask the person if they have a plan for suicide. The
three questions you need to ask are:                                             The person I am trying to help has injured themselves, but
1. Have you decided how you would kill yourself?                                 insists they are not suicidal.What should I do?
2. Have you decided when you would do it?                                        Some people injure themselves for reasons other than suicide. This
                                                                                 may be to relieve unbearable anguish, to stop feeling numb, or other
3. Have you taken any steps to secure the things you would need to               reasons. This can be distressing to see. There are guidelines in this
   carry out your plan?                                                          series entitled First aid guidelines for deliberate self-injury which can
A higher level of planning indicates a more serious risk. However,               help you to understand and assist if this is occurring.
you must remember that the absence of a plan is not enough to
ensure the person’s safety. All thoughts of suicide must be taken
                                                                                 A final note
seriously.                                                                       Do your best for the person you are trying to help.
Next, you need to know about the following extra risk factors:                   Remember, though, that despite our best efforts, some people will
                                                                                 still die by suicide.
•    Has the person been using alcohol or other drugs? The use of
     alcohol and other drugs can make a person more susceptible to
     acting on impulse.
    The MHFA Training & Research Program                                                         Professor Tony Jorm, ORYGEN Research Centre
    ORYGEN Research Centre                                                                            Locked Bag 10, Parkville VIC 3052 Australia
    Department of Psychiatry The University of Melbourne AUSTRALIA                                               email:

                             All MHFA guidelines can be downloaded from


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